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What to know about hirsutism

Hirsutism refers to coarse or colored hair that grows on the face and body of some women. It might sometimes result from a medical condition.

Most women have fine, pale, faintly visible hair on the face and body, but this hair might sometimes be thicker and more visible.

About half of all people with hirsutism have an excess of androgens. These hormones usually trigger male physical and sexual development. Women normally have low androgen levels, but these levels might vary for a range of reasons.

Higher levels can overstimulate the hair follicles, leading to more hair growth than a woman would normally experience.

Hirsutism could occur in anywhere between 5 and 10 percent of women depending on local and cultural definitions of a "normal" amount of hair.

Causes

Increased levels of androgens or oversensitivity of the hair follicles to androgens can cause hirsutism.

Although androgens are available to men at higher levels, women also have these hormones in smaller quantities.

Male hormones, such as testosterone, stimulate hair growth, increase body size, and intensify the growth and pigmentation of hair.

High levels of insulin, a hormone that "unlocks" cells to absorb energy from sugars, might also contribute to the development of hirsutism. Insulin can stimulate the ovarian cells to produce androgens.

High levels of insulin may also activate the insulin-like growth factor-I (IGF-1) receptor in those same cells, similarly increasing androgen production.

Since type 2 diabetes can result from obesity, this too may be a risk factor. High cholesterol may also play a role.

Hirsutism can be an adverse effect of certain medications. Androgen therapy that includes testosterone, dehydroepiandrosterone (DHEA), or the drug Danazol, may contribute to hirsutism.

The body naturally produces DHEA, and some people take it as a supplement to combat age-related conditions, such as osteoporosis. Danazol is a synthetic steroid that sometimes forms a part of endometriosis treatment. Both may raise testosterone as a side effect.

Excessive hair growth in women with normal androgen levels, regular menstrual periods, and no other underlying conditions is called idiopathic hirsutism. This means that the disorder has no identifiable cause.

Hirsutism does not always indicate a significant medical anomaly. However, if it starts before puberty, if it is accompanied by other male-related traits such as a deeper voice, or if it may be due to a tumor, the person should seek medical attention.

Tumors of the adrenal glands, pituitary glands, and ovaries can sometimes lead to hirsutism. However, hirsutism that occurs for this reason will generally be more severe and onset more quickly than with hormonal causes.

Diagnosis

A blood test can help determine testosterone and DHEA levels.

A physician will look at the medical history with a special focus on the menstrual cycle. If the individual has a regular pattern of menstrual periods, the hirsutism is likely to have a genetic or inherited cause.

If menstruation has always been irregular, the cause could be polycystic ovary syndrome (PCOS).

If both the hirsutism and menstrual irregularity have onset recently, and if the woman is missing periods, the healthcare professional may carry out tests for a condition that could be more serious, such as a tumor of the ovaries, adrenal glands, or pituitary gland.

By measuring levels of testosterone and DHEA in the blood, a doctor can check for signs of PCOS, ovarian tumors, adrenal gland tumors, or tumors that can stimulate the adrenal glands.

In cases of mild hirsutism, in which no other symptoms suggesting overproduction of androgen hormones, further testing may not be necessary.

If more testing is necessary, several blood tests are available to test for deficiencies in the adrenal gland hormones. This can cause overgrowth of the adrenal glands.

The doctor may test for levels of the hormone prolactin to check for signs of a tumor in the pituitary gland. They may also check blood sugar and cholesterol levels.

The following might also help to identify tumors or physical irregularities that could have led to hirsutism:

Treatment

If a specific cause of hirsutism becomes clear, the doctor may suggest appropriate treatment for that cause.

If insulin levels are high, reducing them may lead to a reduction in hirsutism.

Women who have a high body mass index (BMI) might find that a weight loss program reduces androgen levels and therefore the symptoms of hirsutism.

Cosmetic approaches

Waxing is an effective but sometimes painful option for removing hair.

Hirsutism can cause distress or embarrassment, but some cosmetic and medical treatments might help decrease androgen levels or their impact on hair follicles.

Effective treatments for mild hirsutism include:

plucking

shaving

waxing

chemical hair softeners

depilatory creams

These can, however, cause irritation on the skin. A person must also repeat these treatments regularly for the desired effects. People should wax every 4 to 6 weeks to keep unwanted hair from growing back.

Laser treatment is more effective for people with some skin types than others, and it does not prevent the formation of new hair follicles. It is expensive and time-consuming, and laser treatment requires the services of a qualified professional, such as a dermatologist or plastic surgeon.

Its effects, however, last longer than those of creams, shaving, or waxing.

Electrolysis also generates heat to prevent hair growth within the follicles but uses electricity instead of light. Electrolysis has become less popular than laser treatment due to its tendency to leave small areas of scarring.

Some medicines can change the impact of androgens on the body and skin.

Combination birth control pills, which contain both estrogen and progesterone, can also counter the effects of androgens and decrease the production of testosterone in the ovaries. Hirsutism may improve after 6 to 12 months of consistently taking birth control pills. Follow the dosage instructions closely.

Anti-androgen medicines work alone or in combination with birth control pills.

Most commonly, a doctor prescribes Aldactone, but others are also available. Do not take anti-androgen medicines during pregnancy.

Prevention

Control hirsutism is not always possible. However, a nutritious, balanced diet and regular exercise can help to control weight and reduce the risk of high cholesterol and diabetes.

Avoiding unnecessary medicines known to cause hirsutism can also reduce the risk.

Q:

If I have idiopathic hirsutism, do I have any methods available for medically managing the condition?

A:

Idiopathic hirsutism is hirsutism without a known cause. Potentially, it may be a mild variation of PCOS, but more research is needed to understand this area. Idiopathic hirsutism and PCOS are treated in similar ways.

You can use the same hair removal techniques, such as:

plucking

shaving

waving

chemical hair softeners

depilatory creams

laser removal

electrolysis

Weight loss might also be helpful in reducing the levels of androgens in your body and, as a result, the amount of hirsutism you may experience.

You will have to discuss with your doctor whether anti-androgen or hormone medications are appropriate for idiopathic hirsutism.

Alana Biggers, MD, MPHAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

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